Bastola Sanjog, Kc Ojbindra, Khanal Sumesh, Halalau Alexandra
Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
SAGE Open Med Case Rep. 2020 Jan 22;8:2050313X20901937. doi: 10.1177/2050313X20901937. eCollection 2020.
Hepatitis-associated aplastic anemia (HAAA) is a rare clinical syndrome characterized by bone marrow failure 1-3 months after development of hepatitis. Untreated, hepatitis-associated aplastic anemia has poor outcome and the mainstay of treatment remains either bone marrow transplant or immunosuppressive therapy. A previously healthy 21-year-old man presented with a 1-week history of right upper quadrant pain and jaundice. Admission labs revealed mixed hyperbilirubinemia and elevated transaminases ranging in 2000s IU/dl. Extensive workup for etiologies of acute hepatitis including viruses, autoimmune, toxins etc. were negative. He admitted to taking "Dust V2," a workout supplement, for 4 months prior to the presentation. His liver function tests started to improve after conservative treatment. Two months after his discharge, he was found to have severe pancytopenia on routine labs. Bone marrow biopsy revealed hypocellular marrow consistent with aplastic anemia. Extensive workup for etiologies of aplastic anemia were negative. On literature review, none of the components of the supplement were found to cause aplastic anemia. A diagnosis of hepatitis-associated aplastic anemia was made as there was a lag time before development of anemia. His counts failed to improve despite treatment with filgrastim and he was referred for hematopoietic cell transplant.
肝炎相关性再生障碍性贫血（HAAA）是一种罕见的临床综合征，其特征为肝炎发生后1 - 3个月出现骨髓衰竭。未经治疗的肝炎相关性再生障碍性贫血预后较差，治疗的主要手段仍然是骨髓移植或免疫抑制治疗。一名既往健康的21岁男性，出现了为期1周的右上腹疼痛和黄疸病史。入院实验室检查显示混合性高胆红素血症，转氨酶升高至2000s IU/dl。针对急性肝炎病因（包括病毒、自身免疫、毒素等）进行的广泛检查均为阴性。他承认在出现症状前4个月一直在服用一种健身补充剂“Dust V2”。保守治疗后他的肝功能检查开始改善。出院两个月后，他在常规实验室检查中被发现患有严重全血细胞减少症。骨髓活检显示骨髓细胞减少，符合再生障碍性贫血。针对再生障碍性贫血病因进行的广泛检查均为阴性。经文献检索，未发现该补充剂的任何成分会导致再生障碍性贫血。由于贫血发生前有一段间隔时间，故诊断为肝炎相关性再生障碍性贫血。尽管使用非格司亭治疗，他的血细胞计数仍未改善，因此他被转诊接受造血细胞移植。
